INTRODUCTION
In the United
States, there are an estimated 8.8 million persons who work in healthcare
professions and about 6 million persons work in more than 6000 hospitals.
However, healthcare is increasingly being provided outside hospitals
in facilities such as nursing homes, freestanding surgical and outpatient
centers, emergency care clinics, and in patientsı homes or during
pre-hospital emergency care. Hospital based personnel and personnel
who provide healthcare outside hospitals may acquire infections
from or transmit infections to patients, other personnel, household
members, or other community contacts.
In this document,
the term healthcare personnel refers to all paid and unpaid
persons working in healthcare settings who have the potential for
exposure to infectious materials, including body substances, contaminated
medical supplies and equipment, contaminated environmental surfaces,
or contaminated air. These personnel may include but are not limited
to emergency medical service personnel, dental personnel, laboratory
personnel, autopsy personnel, nurses, nursing assistants, physicians,
technicians, therapists, pharmacists, students and trainees, contractual
staff not employed by the healthcare facility, and persons not directly
involved in patient care but potentially exposed to infectious agents
(e.g., clerical, dietary, housekeeping, maintenance, and volunteer
personnel). In general, healthcare personnel in or outside hospitals
who have contact with patients, body fluids, or specimens have a
higher risk of acquiring or transmitting infections than do other
healthcare personnel who have only brief casual contact with patients
and their environment (e.g., beds, furniture, bathrooms, food trays,
medical equipment). Throughout this document, terms are used to
describe routes of transmission of infections.
These terms
have been fully described in the "Guideline for Isolation Precautions
in Hospitals." They are summarized as follows:
- direct contact
refers to body surfacetobody surface contact and physical transfer
of microorganisms between a susceptible host and an infected or
colonized person (e.g., while performing oral care or procedures);
- indirect
contact refers to contact of a susceptible host with a contaminated
object (e.g., instruments, hands);
- droplet
contact refers to conjunctival, nasal, or oral mucosa contact
with droplets containing microorganisms generated from an infected
person (by coughing, sneezing, and talking, or during certain
procedures such as suctioning and bronchoscopy) that are propelled
a short distance;
- airborne
transmission refers to contact with droplet nuclei containing
microorganisms that can remain suspended in the air for long periods
or to contact with dust particles containing an infectious agent
that can be widely disseminated by air currents; and, finally,
- common vehicle
transmission refers to contact with contaminated items such as
food, water, medications, devices, and equipment.
In 1983 the
CDC published the "Guideline for Infection Control in Hospital Personnel.
The document focused on the prevention of infections known to be
transmitted to and from healthcare personnel. This revision of the
guideline has been expanded to include
(a) recommendations
for nonpatient care personnel, both in and outside hospitals,
(b) management
of exposures,
(c) prevention
of transmission of infections in microbiologic and biomedical
laboratories, and, because of the common use of latex barriers
to prevent infections,
(d) prevention
of latex hypersensitivity reactions.
As in the 1983
guideline, readers are frequently referred to the "Guideline for
Isolation Precautions in Hospitals" and other published guidelines
and recommendations for precautions that healthcare personnel may
use when caring for patients or handling patient equipment or specimens.
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